Cervical caps and applicators therefor



Jan.

INVENTOR. GERALD C. KOHL A I rO A/EVS 2,818,856 CERVICAL CAPS AND APPLICATORS THEREFOR Gerald C. Kohl, Tacoma, Wash. Application August 29, 1955, Serial-No.531,090 21 Claims. (Cl. 128-127) This invention relates to a new and improved medical device in the nature of a self-retaining cap applicable to the cervix of the uterus, and it is further relates to a-new and improved instrument for introducing 'and applying such a device, also to the unique combination of such a cap and applicator therefor. The invention in'its aspects as named above is herein illustratively described by reference to the presently preferred form thereof; however,

it will be recognized that the illustrative details are subject to modification and change within limitations which will become evident from the present disclosure without departing from the essential features involved.

I Cervical caps have been suggested heretofore. Such devices are to be distinguished from simple diaphragm devices which are merely lodged crosswise in the vaginal vault at the base of the cervix and are retained in this {general object the provision of such a device which, while it may be readily installedand removed, is not injurious nor irritative to the tissues Which-it contacts and, of .particular significancefls to an increased degree self-retaining in its position and capable of-providing an eflective sealing cover for the cervix when installed thereon. Such a device, therefore, is useful for efiective medication of the cervix and uterus, for artificial insemination, and for other or similar purposes.

Another objectof the invention is one of convenience;

namely to provide such a device which may be installed readily and effectively by the patient without aid. 7 d

A related object is an applicator device eifectivefor the convenient installation and removal of a cervix cap or other rimmed, vaginally installed membrane device without the aid of an attending medical doctor.

A specific object is such an applicator and cervical cap with which it is employed, by whichthe final positioning of the cap on the cervix maybe outwardly and positively indicatedto the person handling the instrument. With these and other objects in view novel features of the invention will be seen to reside in the cervix cap construction including provision of a plurality of relatively thin flanges or ribs of soft flexible rubber extending around the inside periphery of the relatively thick elastic rim, and in the seif-everting dome or cervix cover :por-

-tion of the cap joined to said rim additional features reside in certain novel features of the applicator instrument cooperating with the cap; also in the combination of such a cap and instrument whereby reliable seating and indication of seating of the cap'on the cervix is outwardly given. These and other aspects of the invention including certain details of constructionof the preferred form thereof by way of illustration will become more 2,818,856 Patented Jan. 7, 1958 fully evident from the following description by reference to the accompanying drawings.

Figure 1 is a perspective view of the cervical cap and applicator, with certain portions of each broken away for clarity of illustration.

Figure 2 is a sectional side view of the cervical cap installed, the cervix outline being shown by broken. lines.

Figure 3 is a sectional side view of the retaining head of the applicator and the cervical cap retained therein, With the cap and the retainer ring of the head tilted and flattened for introductional purposes.

Figure 4 is an end view of the assembled cap and applicator under the condition established for Figure 3, the view being taken on line 44 in Figure 3.

Figure 5 is a partly sectional side view of the cap and applicator without any flattening or tilt as in Figure 3.

Figure 6is a View similar to Figure 5 but with the applicator in the position 'of completing the installation o-f the cap on a cervix, the latter being shown by broken lines in the figure.

Referring-to thedrawings, the novel c'ervical'cap'comprises two main parts, the thin and relatively flexible non-permeable cup-like membrane or bag portion ltd-arid the semi-rigidor stiff, internally ribbed elastic-rim'zporti-on l-ljoined-edge-to-edge thereto, in the form of a relatively Wide ring. The membrane 10 is preferably'of high-grade surgical rubber of a relatively thin gauge somewhat'havie'r than that used in surgical gloves to give it softness yet considerable flexibility, whereas the body of the "annular rim -1'2-is preferably molded of a similar material and is many times thicker than the membrane-to impart appreciable "form-retaining stiffness to suchrim body. The

membrane 10 tends to assume a concavo-co'nvex --form, that is, is self-everting into its normal dome-like or -cupform, the depth of which is of the order of 'one-half to one inch or '-rnore deep, depending on the patier'it; and the outerand inner walls of the relatively thick and wide elastic rim 12, which effectively extends the "depth-of the cup formed by the membrane *10, are formed-,fis viewed in longitudinal section (Figure 2):, with slightly convex outward curvature, thereby to conform'in-a general way to the convex curvature of the cervix lip-exterior upon which the cervix cap is to be seated as-in thefigure. It'is alsopreferred that the outer end of the band-like rim 12 be chamfered somewhat on the inside edge as indicated at 12a, as :anexpedient which,-at leastin -small measure, facilitates the guidance of the cervix cap to =-a seat on the'cervix.

It will be noted in the drawings that: the width of the annularrim body 12 measured depthwise'of theca'p is a material or major portion of its total depth onlength, so that upon its installation, the rim portion -1-2 will directly surround and overlie an appreciable portion of the projecting-length of the cervix. Ahighl-y important feature of the invention is the provision'of'relatively thin and flexible annular internal ribs on the interior pf the rim portion 12, which are of resiliently flexible soft material such as a good grade of surgical rubber, and which have such a thickness and projecting'width ratio, that they possess a certain degree of stifiness for-a purpose later explained in some detail. Deflection of these resilient ribs 12b axially of the cap, accompanied "by expansion of such ribs against their elastic force, b'c' 'is during progressive insertion of the cervix wedging'Iy -nt'o the cap interior during application of the cap-as i'n Figure 2. The springing of the ribs toward the base of the cap as shown in this figure occurs by varying degrees depending upon the relative curvatures of, hence uponft lie distances separating "the cervix exterior and the insi'dewal l of the rim 12 from which the ribs project. Such separa tion determines the amount of deflection of the individual ribs, i. e., some may be deflected more than others, but in each instance the projecting inner edge portion of each rib bears inwardly on the cervix exterior by the contractile force of the deflected and stretched rib and thereby tends to press into the cervix tissue in a manner holding the cap in place on the cervix. At the same time, the series of annular zones in which the ribs have their greatest pressure of contact with the cervix exterior provide a highly effective fluid-tight seal between the cap rim 12 and the cervix. The formation of such a seal is also eifective in holding the cap in place because of the partial vacuum which is established in the process of installing the cap, (viz. created primarily by self-eversion of the cap dome permitted by seating of the cap and actuation of the indicator element in the applicator which held the dome inverted during insertion) which vacuum is not so great, however, as to preclude the ready removal of the cap when desired, especially with the aid of the applicator instrument, as later disclosed.

At least one and preferably a plurality, such as three or more, of the ribs 12b are provided on the interior of the stiflening rim or band 12 of the cervical cap, and these are located at such a spacing measured lengthwise of the cap that neither rib interferes with the action of the other, but closely enough together to permit all to contact the cervix exterior as near as possible to the base thereof, so that they will engage the region of least convergence of the cervix exterior and the cap will be best able to retain itself in place. The thickness of the ribs 12b measured lengthwise of the cap is a matter of design, but for best results in terms of holding and sealing effect of the ribs, it is found that they should be of the order of thickness of the membrane 10. It will be recognized that no attempt is made in the drawings to show the precise optimum thickness of these elements, nor the precise optimum relationship of thicknesses. While the rib thickness is not especially critical, it is preferred that these ribs be not materially thicker than of the order of $6 of an inch, since being of annular form, they are required to stretch slightly by insertion of the cervix into the cap. They must stretch readily for that purpose, hence cannot be too thick. Nevertheless, unless they have appreciable thickness they will not be sufl'iciently stifi to maintain their deflected form as shown in Figure 2, wherein they are capable of resisting appreciable endwise thrust load imposed upon them by forces tending to remove the cap from the cervix. In other words, to some extent they must be capable of serving as compression members in order to carry thrust load without buckling or folding completely under such load due to excessive flexibility so as to assume a reversely deflected position in response to such load and thereby become less effective to resist sliding of the cap off the cervix.

The cap rim body 12 should be of semi-rigid elastic or resilient construction for purposes or retaining its form, and yet it should be suiflciently flexible that it may readily be compressed and flattened between the fingers of the hand for insertion purposes, and so that it may, to some degree, conform itself to the longitudinal curvature. of the cervix upon installation, thereby to improve the selfretaining property of the cap. If the shape of the particular cap rim body 12 is generally conformed to the cervix longitudinal curvature however, the latter reason for providing some flexibility of the rim body 12 is not of particular importance, because of the capable holding 4 thereof, an actuator means 2t for compressing and flattening the cap-retaining head for convenience in insertion and removal of the cap, and an indicator device to be described by which the final seating of the cervical cap on the cervix is outwardly indicated and by which the cap dome is held inverted during insertion as part of the system for creating a slight vacuum in the cap as it assumes its final form and position on the cervix.

The retaining head 14 is cup-like in form. It comprises the relatively stiff elastic ring 14a of such form and size as to snugly accommodate the cervical cap rim 12 therein, as shown in Figures 3, 5 and 6. The inside annular wall surface of the ring 14a converges toward the base of the retaining head in an outward slightly convex curvature, in approximate conformity to the taper of the external annular surface of the cap rim 12. Thus, the cap may be nested snugly in the retaining head to establish a relatively secure but releasable grip on the cap. The retaining head or ring 14a is sufficiently stiif forretaining its form normally, but is sufliciently flexible to permit flattening the same between the fingers, as shown in Figure 4, wherein the assembled cap and retaining head are being squeezed into a flattened form for insertion purposes. The bottom of the'cup-like retaining head 14 is formed by a flexible membrane or wafer 14b of surgical rubber or other suitable material, and is made permeable to liquids by a plurality of small apertures 14b therein. This flexible membrane 14b is joined around its entire periphery to the base edge of the ring 14a at 14a. Of generally cup-like form, this membrane is made permeable to prevent the development of a suction during application of the cervical cap, which would tend to hold the cap too firmly in the retaining head and thus prevent leaving the cap deposited on the cervix when the applicator is withdrawn.

The elongated tubular handle 16, which is approximately eight inches in length or thereabouts, carries on opposite sides thereof a pair of elongated supporting arms 22 and 24 for the head 14, which arms are pivotally connected to respectively opposite sides of the ring 14a at the base edge of such ring as indicated at 140. These resilient arms are joined to the tubular handle 16 near the outer end thereof, i. e., the end remote from the retaining head 14, and from their point of connection to the handle diverge toward the retaining head which they support. A slider sleeve 26 having a flange 28 thereon serving as a sleeve handle is slidable longitudinally on the tubular handle 16 and may be advanced along the latter progressively to press the resilient arms 22 and 24 toward each other as it does so. This causes the resilient ring 14a to be flattened in a plane perpendicular to the common plane of the arms 22 and 24, or to be held in flattened condition in such plane. The tubular handle 16 has an enlargement or flange 16a on the outer end thereof for convenience in grasping the same and as a gauge reference element for a purpose to be described below.

The pivotal connection at between the retaining ring 1411 and the ends of the respective arms 22 and 24 permits the ring to tilt in a plane perpendicular to the common plane of the arms 22 and 24 about an axis transverse to the longitudinal axis of the handle. Vaginal insertion of the retaining head carrying the cervical cap is greatly facilitated if the retaining head and cap are both flattened, as shown in Figure 4, and tilted relative to the longitudinal axis of the handle, as shown in Figure 3, during the insertion process.

An indicator rod 30 extends slidably lengthwise through the tubular handle 16 and carries an indicator knob 30a on its outer end, whereas its inner end carries a flange 3% which slides freely lengthwise in the tube 16 and serves as a seat for a flexible extension 300 of such rod. The flexible extension 300 is in the form of a helical spring, the coils of which contact one another, and the end of which opposite from that connected to the flange 5 30b is suitably fastened at 300' to the relativelyadjacent side of the cupped membrane 1412. 'In effect, the flexible rod extension 300 is a compression member that holds the cap dome inverted initially and which transmits longitudinal thrust from the cervix through membrane 14b to the rod 30 when the membrane contacts the end of the cervix, as in Figure 6, during installation of the cervical cap on the cervix. A degree of flexibility of the extension 300 for this purpose is desirable because of the angularity existing between the cervix axis and the axis of the vaginal tract through and along which the instrument extends as the cap is being applied. Before the rod 3 is displaced endwise by cervical contact a compress1on spring 34 lodged between the flange 30b and a suitable stop 16b inside the tubular handle 16 reacts against the indicator assembly to hold the indicator knob 30a in its initial position adjacent flange 16a, as shown in Figure 5. Upon the final seating of the cervical cap on the cervix the indicator rod 30 is advanced lengthwise in the tubular handle 16, and the resulting outward displacement of the indicator or gauge knob 30:: from the handles end flange 16a, serving as a gauge reference, outwardly indicates the fact of completion of the installation.

An elastic tubular bellows-like element 36 surrounding the flexible rod extension 30c, interconnects the distal or inner end of the tubular handle 16 at 36a, and the membrane 14b. The bellows serves as a resilient means normally holding the retaining head 14 in a position approximately perpendicular to the longitudinal axis of the instrument, as shown in Figure 5, that is, in the nontilted position. At the same time, the resilient bellows 36 is sufliciently flexible that during the seating operation, as shown in Figure 6, it will permit adequate tilting of such retaining head, as it does during the installing operation when the head is tilted as in Figure 3.

In order to employ the disclosed applicator for install- 1ng and removing the cervical cap, the sequence is preferably as follows:

With the cap firmly seated in the retaining head 14 as shown in Figure 5, and with medical fluid contained in the cap if desired, the two are flattened as indicated in Figure 4, and maintained in flattened condition by advancing the slider sleeve 26 lengthwise of the handle to hold together the resilient arms 22 and 24. At the same time, the hand is used to tilt the cap-retaining head relative to the longitudinal axis of the instrument as shown in Figure 3. Such combined tilting and flattening of the head assembly permits easy vaginal introduction of the same, and after introduction thereof the slider tube sleeve 26 is again retracted to permit resilient expansion of the arms 22 and 24 away from each other, so that the cervical cap retained in the head 14 again assumes a round form. The force of spring 34 thrusts the members 30c and 300 endwise against the diaphragm 14b which inverts the same hence also the cap dome 10. The instrument carrying the cap is then advanced through the vaginal tract toward the cervix until the cap is seated as in Figures 2 and 6. The final seating operation requires some accommodative tilting of the head 14 relative to the axis of the instrument, and accompanying flexure of the bellows 36 and flexible rod extension 300, but this takes place readily due to the realigning forces which inherently develop during the seating operation. Chamfering of the free edge of the cervical cap rim 12 at 12a facilitates guiding the cap onto the cervix. As the cap becomes seated, and the end of cervix contacts the end of the flexible rod 300, through the two membranes 10 and 14b, a thrust force is developed which causes the indicator knob 30 to move outwardly from the handles end and thereby indicate completion of the installation. Also it permits partial or complete eversion of the dome 10, creating a slight vacuum in the cap, as desired for purposes of retaining the cap in place. The instrument 6 is 'then retracted, leaving the cervical cap installed on the cervix.

'In order to remove the cervical 'cap'from the cervix, the instrument is reinserted following a procedure similar to that just described, and when the relative displacement of the indicator knob 30a indicatesthat the cervical cap rim '12 is firmly seated in the retaining ring 14a, the cap is worked loose from 'the cervix by a slight lateral oscillating movement imparted to the instrument accompanied by a pressing together of the arms 22 and 24 be tween the fingersor by advancement of the sleeve 26, so as to grip the cap rim 12 more firmly than otherwise. The cap may 'be worked loose from the cervix in this or a siniilarmanner and'thus withdrawn.

It will be evidenttherefore that a novel cervical cap and indicating applicator therefor have been devised and it will further be recognized that the essential features of the invention may be practiced in varying forms and modifications without exceeding the scope thereof.

I claim as my invention:

1. A cervical cap comprising a relatively thin and flexible but resilient and self-everting, impermeable cap membrane of cup form, a relatively thick and stiff cap rim member joined to said cap membrane continuously around the perimeter thereof, said rim member having form-retaining elasticity and a degree of flexibility permitting appreciable flattening of the same readily by manual applied pressure, and a plurality of substantially parallel relatively thin and flexible soft elastic annular rib elements joined to and extending around the inside of said rim member at relative locations thereon spaced apart in the direction of depth of said cap, said rib ele-. ments being deflectable toward said membrane by application of said cap to a cervix to which said rim member is generally fitted and thereby serving to retain and seal said cap on the cervix.

2. A cervical cap comprising a relatively thin and flexible but self-everting resilient bag of impermeable elastic material, a semi-rigid and resiliently flexible cap rim member joined to said cap membrane continuously around the perimeter thereof, and at least one relatively thin and flexible soft elastic annular rib element joined to and extending around the inside of said rim member in substantially perpendicular relationship to the axis of said cap, said rib element being deflectable toward said bag by application of said cap to a cervix to which said rim member is generally fitted and thereby serving to retain and seal said cap on the cervix. I

3. The cervical cap defined in claim 2, wherein the rim member is relatively wide in the direction of cup depth, and has an inside Wall of slightly outwardly convex curvature between opposite angular edges thereof, conforming approximately to cervix curvature.

4. The cervical cap defined in claim 3, wherein the cap has a plurality of the rib elements joined to the rim member at successive locations spaced apart therealong in the direction of cup depth arid normally extending generally in parallel planes perpendicular to the cap axis when said rib elements are undeflected.

5. A self-retaining cervical cap comprising a relatively thin, soft and resiliently form-assuming rubber-like bag, thin, soft and resiliently flexible form-assuming rubberlike bag of generally dome like form, a relatively thick,

semi-rigid and resiliently flexible rubber-like rim member joined to said bag continuously around the perimeter thereof, and a plurality of relatively thin and flexible soft rubber-like annular rib elements joined to and extending around the inside of said rim member, said rib elements being deflectable toward said bag by application of said cap to a cervixto which said rim member is generally fitted and thereby serving to retain and seal said cap on the cervix.

6. An applicator for a cervical cap of the type generally comprising a relatively thin, soft and flexible, im-

permeable membrane of cup form and a relatively thick, semi-rigid and resiliently flexible rim member joined continuously to the membrane around the perimeter thereof, said applicator comprising an annular semi-rigid and resiliently flexible cup-like holder element adapted to retain the cervical cap nested snugly therein, an elongated handle means, holder support means fixed to said handle means and supportingly connected to said holder element for normally maintaining the latter substantially coaligned with said handle means while permitting tilting of said holder element relative to said handle means, and means operable to indicate seating of the cervical cap on a cervix, comprising an elongated element carried by said elongated handle means to extend lengthwise thereof and slidably lengthwise relative thereto, said elongated element having one end portion projecting from said handle means normally into the interior of said annular holder element to be engaged by and thrust endwise by contact with the cervix during application of the cap thereto, and said elongated element having gauge means on the end portion thereof opposite from said first end portion, said gauge means being movable from an initial position to a displaced position relative to the handle means accompanying said endwise thrust of the elongated element thereby to indicate seating of said cap.

7. The applicator defined in claim 6, wherein the handle means is of tubular form, and the elongated el ment comprises a rod slidably received in said tubular handle and the first end portion whereof includes a flexible extension portion of such rod.

8. The applicator defined in claim 7, wherein the holder element includes a flexible cup-like permeable membrane connected across the end of the annular holder element adjacent the handle means, the first-mentioned end portion of the elongated element being connected to said latter membrane.

9. The applicator defined in claim 8, wherein the holder support means comprises a pair of resilient arm members secured at one end to the handle means at respectively opposite side locations between the opposite ends of said handle means, and projecting from said handle means in divergent relationship toward the holder element, and means connecting the projecting ends of said resilient arm members to respectively opposite sides of said holder means to permit tilting of the latter relative to the handle means generally about an axis perpendicular to the length of the handle means and contained generally in the common plane of said arms.

la). The applicator defined in claim 9, and an elongated tubular bellows member of resilient material surrounding the flexible rod extension portion and connected at one end to the handle means and at its opposite end to the holder element, said bellows member normally urging said holder element into non-tilted relationship relative to the handle means.

ll. The applicator defined in claim 10, anda slider sleeve encircling the handle means and slidable lengthwise thereof to overlap progressively on the'divergent resilient arm members for drawing the same progressively together by sliding of said sleeve toward the holderelement, thereby'to flatten the latter and the cervical cap nested therein 12. The a icator defined in claim 6, wherein the hold-er element includes a flexible cup-like permeable membrane cc nected across the end of the annular holder element a the handle means, the firstmentioned end portion o: the elongated element being connected to said latter membrane.

l3. applicator defined in claim 6, wherein the holder support means comprises a pair of resilient arm members secured at one end to the handle means at respectively op osite side locations between the opposite ends of said handle means, and projecting from said handle means in divergent relationship toward the holder element, and means connectingthe. projecting ends of said resilient arm members to respectively opposite sides of said holder means to permit tilting ,of thelattcrrelative to the handle means generally about an axis perpendicular to the length of the handle means and contained generallyin the common plane or" said arms;

14., The applicator defined in claim 13, and a slider sleeve encircling the handle means and slidable lengthwise thereof to overlap progressively on the divergent resilient arm members for drawing the same progressively together by sliding of said sleeve toward the holder element, thereby to flatten the latter and the cervical cap nested therein.

15. In combination, a cervical cap comprising a relatively thin, soft and flexible, impermeable membrance of cup form and a relatively thick, semi-rigid and resiliently flexible rim member joined continuously to the membrane around the perimeter thereof and having a plurality of annular relatively thin and resiliently flexible cervixgripping ribs extending around the inside thereof, and an applicator for said cap comprising an annular semirigid and resiliently flexible cup-like holder element retaining the cervical cap nested snugly therein, an elongated handle means, holder support means fixed to said handle means and supportingly connected to said holder element for normally mm'ntaining the latter substantially coaligned with said handle means while permitting tilting of said holder element relative to said handle means, and means operable to indicate seating of the cervical cap on a cervix, comprising an elongated element carried by said elongated handle means to extend lengthwise thereof and slidably lengthwise relative thereto, said elongated element having one end portion projecting from said handle means normally into the interior of said annular holder element to be engaged by and thrust endwise by contact with the cervix during application of the cap thereto, and said elongated element having gauge means on the end portion thereof opposite from said first end portion, said gauge means being movable from an initial position to a displaced position relative to the handle means accompanying said endwise thrust of the elongated element thereby to indicate seating of said cap.

16. The applicator defined in claim 15, wherein the handle means is of tubular form, and the elongated element comprises a rod slidably received in said tubular handle and the first end portion whereof includes a flexible extension portion of such rod.

17. The applicator defined in claim 15, wherein the holder element includes a flexible cup-like permeable membrane connected across the end of the annular holder element adjacent the handle means, the first-mentioned end portion of the elongated element being connected to said latter membrane.

18. The applicator defined in claim 17, wherein the holder support means comprises a pair of resilient arm members secured at one end to the handle means at respectively opposite side locations between the opposite ends of said handle means, and projecting from said handle means, in divergent relationship toward the holder element, and means connecting the projecting ends of said resilient arm members to respectively opposite sides of said holder means to permit tilting of the latter relative to the handle means generally about an axis perpendicular to the length of the handle means and contained generally in the common plane of said arms.

19. An instrument for installing an annular relatively stilt-rimmed cup-like membranous medical device vaginally, said instrument comprising an annular ring-like device holder element adapted to receive and hold such a device therein and elastically deformable to permit flattening of said holder element and the device held therein, handle means having an outer end and having an inner end tiltably connected to said holder element to permit relative l t g thereof in flattened condition thereby to permit vaginal insertion thereof, and indicator means carried by the handle means, said indicator means including an elongated member movable lengthwise of said handle means, a member connected to said elongated member and normally located within the holder element to be displaced by entry of the cervix into said holder element, thereby to efiect movement of said elongated member, and an indicator element connected to said elongated member in the vicinity of the outer end of the handle means, movable thereby relative to said handle means to indicate such cervix entry.

20. An instrument for installing an annular relatively stilt-rimmed cup-like membranous medical device vaginally, said instrument comprising a holder element adapted to receive and hold such a device therein and resiliently deformable to permit flattening of said holder element and the device held therein, said elongated handle means having an outer end and having an inner end tiltably connected to said holder element to permit relative tilting thereof in flattened condition thereby to permit vaginal insertion thereof, and indicator means carried by the handle means, said indicator means including an elongated member movable lengthwise of said handle means, a member conected to said elongated member and normally disposed to project into the holder element interior for 25 deflecting the medical device membrane outwardly thereof away from said handle means, and thereby in position to be displaced toward said handle means by entry of the cervix into said holder element, thereby to effect movement of said elongated member, and an indicator element connected to said elongated member in the vicinity of the outer end of the handle means, movable thereby relative to said handle means to indicate such cervix entry.

21. An instrument for installing an annular relatively stifi-rimmed membranous medical device vaginally, said instrument comprising an annular ring-like device holder means adapted to receive and hold such a device therein and elastically deformable to permit flattening of said holder means and the device held therein, and means carried by said handle means tiltable supporting said holder means thereon in a manner permitting both tilting and flattening of said holder means and held device thereby to permit vaginal insertion thereof, said supporting means comprising a pair of resilient arm members secured at one end to the handle means at respectively opposite side locations between the opposite ends of said handle means, and projecting from said handle means in divergent relationship toward the holder element, and means connecting the projecting ends of said resilient arm members to respectively opposite sides of said holder means to permit tilting of the latter relative to the handle means generally about an axis perpendicular to the length of the handle means and contained generally in the common plane of said arms.

References Cited in the file of this patent FOREIGN PATENTS 55,186 Austria Sept 10, 1912 162,851 Switzerland Sept. 16, 1933 243,186 Great Britain Nov. 26, 1925 OTHER REFERENCES Conception Control by Plastic Cervix Corp., Granfenberg and Dickinson, W. J. of S., O & G, August 1944.

U. S. DEPARTMENT OF COMMERCE PATENT OFFICE CERTIFICATE 0F CORRECTION Patent No 2,818,856 January '7, 1958 Gerald G a Kohl It is hereby certified that error appears in the printed specification of the above numbered patent requiring correction and that the said Letters Patent should read as corrected below.

Column 6, line 62, strike out "thin, soft and resiliently form assuming rubber like bag, r,

Signed and sealed this llth day of March 1958;,

SEAL ttesizz KARL H, AXLINE ROBERT C. WATSON Attestlng Officer Comnissioner of Patents 

